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- 2018
PSAD联合PI-RADS v2在前列腺穿刺活检灰区的效用评估
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Abstract:
摘要 目的 探讨前列腺特异性抗原密度(PSAD)联合前列腺影像报告和数据系统第2版(PI-RADS v2)在前列腺穿刺活检灰区的价值.方法 回顾分析行前列腺穿刺活检患者85例,穿刺前行多参数磁共振成像(mpMRI)检查且血清前列腺特异性抗原(PSA)质量浓度为4~10 ng/mL的患者纳入研究,进行PI-RADS v2评分和计算PSAD值,再根据穿刺病理结果,基于Gleason评分,对患者的PSAD联合PI-RADS v2评分进行统计学分析,使用受试者工作特征曲线(ROC)计算曲线下面积(AUC),评估PSAD联合PI-RADS v2在前列腺穿刺活检灰区的诊断价值.结果 85例血清PSA质量浓度为4~10 ng/mL的患者中,穿刺活检病理结果显示前列腺良性病变(包括前列腺增生、前列腺肉芽肿性病变和前列腺炎)70例(82.35%,70/85),前列腺癌15例(17.65%,15/85).前列腺癌(PCa)组和前列腺良性组PSAD、PI-RADS v2评分独立样本t检验结果显示PCa组和前列腺良性组间PSAD、PI-RADS v2评分均有统计学差异(P值分别为0.008、<0.001,均<0.05).PSAD、PI-RADS v2、PSAD+PI-RADS v2在诊断前列腺癌受试者工作特征曲线(ROC)下面积(AUC)逐渐增高,分别为0.721、0.842和0.869.当以PSAD质量浓度>0.17 ng/mL/cm3或PI-RADS v2评分≥4分为最佳截断点(cut off)时,PSAD+PI-RADS v2评分联合应用,前列腺穿刺活检灰区诊断PCa的敏感性为86.69%,特异性为64.29%.结论 血清PSA质量浓度为4~10 ng/mL前列腺穿刺活检灰区中,以前列腺穿刺病理Gleason评分为金标准,PSAD+PI-RADS v2评分联合应用,对前列腺穿刺活检灰区诊断PCa有较显著的临床价值,能够优化PSA筛查后的临床决策.
| [1] | WEINREB J C,BARENTSZ J O,CHOYKE P L,et al.PI-RADS prostate imaging-reporting and data system:2015,version 2[J].Eur Urol,2016,69(1):16-40. |
| [2] | 那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南手册(2014版)[M].北京:人民卫生出版社,2014. |
| [3] | NA Y Q,YE Z Q,SUN Y H,et al.CUA guidelines on diagnosis and treatment of diseases in department of urology(Version 2014)[M].Beijing:People’s Medical Publishing House,2014. |
| [4] | VARGAS H A, HOTKER A M, GOLDMAN D A, et al.Up-dated prostate imaging reporting and data system(PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference[J]. Eur Radiol, 2016, 26(6):1606-1612. |
| [5] | MULLER B G, SHIH J H, SANKINENI S, et al.Prostate cancer: interobserver agreement and accuracy with the revised prostate imaging reporting and data system at multiparametric MR imaging[J]. Radiology, 2015, 277(3):741-750. |
| [6] | FENG Z Y, WANG L, MIN X D, et al.Prostate Cancer Detection with Multiparametric Magnetic Resonance Imaging: Prostate Imaging Reporting and Data System Version 1 versus Version 2[J]. Chin Med J (Engl), 2016,129(20):2451-2459. |
| [7] | EGEVAD L,MAZZUCCHELLI R,MONTIRONI R.Implications of the international society of urological pathology modified gleason grading system[J].Arch Pathol Lab Med,2012,136(4):426-434. |
| [8] | EPSTEIN J I,ZELEFSKY M J,SJOBERG D D,et al.A contemporary prostate cancer grading system: a validated alternative to the Gleason Score[J].Eur Urol,20l6,69(3):428-435. |
| [9] | 韩苏军,张思维,陈万青,等.中国前列腺癌发病现状和流行趋势分析[J].临床肿瘤学杂志,2013,18(4):330-334. |
| [10] | HAN S J,ZHANG S W,CHEN W Q,et al.Analysis of the status and trends of prostate cancer incidence in China[J].Chinese Clinical Oncology,2013,18(4):330-334. |
| [11] | CHEN R,SJOBERG D D,HUANG Y,et al.Prostate specific antigen and prostate cancer in Chinese men undergoing initial prostate biopsies compared with western cohorts[J].J Urol,2017,197(1):90-96. |
| [12] | ALBERTS A,ROOBOL M,DROST F J,et al.PSA-density based patient selection for MRI-targeted prostate biopsy could reduce unnecessary biopsy procedures in men on active surveillance for low-grade prostate cancer[J].Eur Urol Suppl,2017,16:e856-e858. |
| [13] | NIU X K,LI J,DAS S K,et al.Developing a nomogram based on multiparametric magnetic resonance imaging for forecasting high-grade prostate cancer to reduce unnecessary biopsies within the prostate-specific antigen gray zone[J].BMC Medical Imaging,2017,17(11):1-9. |
